3D-DSA诊断急性破裂性颅内动脉瘤的临床意义

Clinical Significance of 3D-DSA in the Diagnosis of Acute Rupture d Intracranial Aneurysms

目的探讨三维数字减影血管造影(3D-DSA)在急性破裂性颅内动脉瘤诊断中的应用价值。方法选取2020年1月至2022年1月本院收治的89例疑似急性破裂性颅内动脉瘤患者为研究对象。所有患者均于术前接受3D-DSA、3D-CTA检查,比较两种方法阳性检出率,并以手术后病理结果为金标准,分析两种方法诊断效能,另分析两种方法与手术病理结果一致性。结果89例疑似患者经手术证实为急性破裂性颅内动脉瘤81例,3D-CTA检出73例,阳性检出率为90.12%(73/81);3D-DSA检出80例,阳性检出率为98.77%(80/81);3D-DSA阳性检出率高于3D-CTA,差异具有统计学意义(χ^(2)=4.235,P=0.040);3D-DSA诊断灵敏度、准确度为98.77%、98.88%,高于3D-CTA的88.89%、88.76%,差异有统计学意义(P<0.05);kappa检验显示,3D-CTA与手术病理结果一致性尚可(kappa值=0.527,P=0.000);3D-DSA与手术病理结果一致性极好(kappa值=0.935,P=0.000)。结论3D-DSA在急性破裂性颅内动脉瘤中的诊断价值优于3D-CTA,能够提高诊断灵敏度、准确度,减少漏诊发生,避免延误患者救治时机。

Objective To evaluate the value of three-dimensional digital subtraction angiography(3D-DSA)in the diagnosis of acute ruptured intracranial aneurysms.Methods A total of 89 patients with suspected acute ruptured intracranial aneurysms admitted to our hospital from January 2020 to January 2022 were selected as the study subjects.All patients were examined by 3D-DSA and 3D-CTA before operation.The positive detection rates of the two methods were compared.The diagnostic efficacy of the two methods was analyzed with surgical pathology as the gold standard,and the consistency between the two methods and surgical pathology was analyzed.Results A total of the 81 suspected patients were confirmed as acute ruptured intracranial aneurysms by surgery,A total of 73 were detected by 3D-CTA,and the positive rate was 90.12%(73/81);A total of 80 cases were detected by 3D-DSA,and the positive rate was 98.77%(80/81);The positive detection rate of 3D-DSA was higher than that of 3D-CTA,and the difference was statistically significant(χ^(2)=4.235,P=0.040);The diagnostic sensitivity and accuracy of 3D-DSA were 98.77%and 98.88%,which were higher than those of 3D-CTA(88.89%and 88.76%)(P<0.05);Kappa test showed that the consistency between 3D-CTA and surgical pathological results was acceptable(kappa value=0.527,P=0.000);The consistency between 3D-DSA and surgical pathology was excellent(kappa=0.935,P=0.000).Conclusion 3D-DSA is superior to 3D-CTA in the diagnosis of acute ruptured intracranial aneurysms.It can improve the diagnostic sensitivity and accuracy,reduce the occurrence of missed diagnosis,and avoid delaying the opportunity of treatment.